We are well on the way of educating all independent thought out of our medical students and residents.
Innovative approaches and individualized treatment based on understanding of pathophysiology, pharmacology, genomics, and psychosocial concerns will completely disappear in not very long.
Cookbook medicine works best in patients with straightforward conditions who are likely to get better on their own or with minimal intervention. Thus, many cookbook approaches wind up overtreating patients who need little or no treatment. The expensive and unnecessary emergency room care that is routinely delivered according to “metrics” is a good example.
Cookbook becomes less effective, and even injurious, as patients and their illnesses become more complex. A well-trained experienced physician who is trained to “split hairs” can usually tune through the static and deliver effective and focused treatment earlier, when it is likely to be more effective. This requires detailed analysis, careful analytic thought, and usually, approaches outside the algorithms that direct our modern trainees.
On a personal note, on a daily basis I receive faxes from insurance drug plans wanting to know the patient’s DIAGNOSIS. Now, some of these drugs are prescribed for only one reason, e.g. HIV/AIDS, so only a clueless moron would need a diagnosis code.
More importantly, it not necessary for a dispensing pharmacy to know the patient’s diagnosis: all they need is a legible prescription from a licensed physician. Adding a diagnosis code just makes it easier for a patient’s private information to be divulged by unauthorized database access or a malicious drone working for the insurance plan.
So far, good humor and politesse have ruled my responses to these requests: I write “You do not need this information to dispense this drug” in the space for “Diagnosis.”
I can forsee the day when I snap and enter, “None of your f***ing business!”
I beg your pardon, but this is not the case. A pharmacist's mandate includes dispensing the correct drug for the patient's disease, and the pharmacist is both ethically and legally liable if a drug is dispensed for an inappropriate indication. They may not ask all the time, but if they do they generally have a good reason.